Increasing Accessibility of Laparoscopic Surgery in Low- and Middle-Income Countries

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Abstract Laparoscopic surgery is the standard of care in high-income countries (HICs) for many cancer operations in the chest and abdomen. Laparoscopic surgery avoids large incisions by using a tiny camera and fine instruments manipulated through keyhole incisions, but it is generally unavailable in low- and middle- incomes countries (LMICs) due to high cost of installment, lack of qualified maintenance personnel, unreliable electricity and shortage of consumable items. Patients in LMICs would benefit from laparoscopic surgery, as advantages include: decreased pain, improved recovery time, fewer wound infections, and shorter hospital stays. Laparoscopic surgery would reduce recovery time, enabling patients to return to home and work more quickly, thereby mitigating impoverishing health expenditure. Laparoscopic technology can be developed that is low-cost, durable, and does not require a constant supply of consumable items or electricity. This would enable laparoscopic surgery to be performed in rural hospitals, where the majority of patients live. We describe a multi-disciplinary collaboration between surgeons and engineers in the U.S. and Uganda to develop a laparoscopic system for use in LMICs. The laparoscopic system will be designed for a cost of goods < $200. Rather than using the current design of fiber optic cables, our prototype has been constructed with low-cost light emitting diodes (LEDs) and a color complementary metal-oxide-semiconductor (CMOS) detector that has been moved to the front of the device. This allows for a maintenance-free and low-cost laparoscope. Images can be displayed on a laptop computer, obviating the need for expensive monitors and cables and preventing loss of function during power-outages. The laparoscopic system also includes a prototype retractor for lift-laparoscopy, which obviates the need for a constant power supply and medical-grade carbon dioxide availability. In the proposed research, the current prototypes will be modified according to feedback from LMIC and HIC surgeons. Safety parameters of the device will be tested in an in vivo porcine model. Clinical data on current laparoscopic cases in Uganda will be collected to assess baseline rates of post-operative complications and difficulties with laparoscopic equipment, which will inform the design of a future clinical study to test the laparoscopic system in a clinical environment.